Piriformis syndrome is a condition where sciatica symptoms occur due to involvement of the piriformis muscle, often caused by muscle tightness or trauma. It results in entrapment of the sciatic or pudendal nerves, leading to pain, tingling, and numbness in the buttocks, thigh, and leg. Diagnosis involves physical tests like the Freiberg test and treatment focuses on stretching, strengthening, and modalities like massage to relieve tightness while surgery is rarely needed.

1. Piriformis Syndrome
By Laura Sandve
&
Andy Coleman

2. • Sciatica symptoms due to an involvement of the
piriformis muscle
• Often referred to as “Wallet Sciatica” or “Fat
Wallet Syndrome”
• Entrapment of one or more nerves
– Sciatic
– Pudendal
Pathophysiology

3. • Tightness or spasms of the piriformis
• Trauma to the piriformis
• Weak gluteals
• Sitting on thick wallet for long periods of time
Possible Causes

4. • Higher incidence in females
– 6:1 ratio
• Total hip arthroplasty
• Excessive pronation
• Strengthening without stretching
• Sciatic nerve passing through the piriformis
– About 15-30% of the population
Risks

5. • Sciatic Entrapment
– Pain, tingling, numbness
• Buttocks, posterior thigh, hip, leg
– Radiating
• Tenderness in the area of the
sciatic notch
Signs and Symptoms

6. • Pudendal Entrapment
– Pain, tingling, numbness
• Coccyx, groin
– May cause bowel and/or bladder incontinence
Signs and Symptoms

7. • Beatty Maneuver
• Freiberg Test
– Pictured
• Pace Test
• Muscle injections
– Usually an anesthetic and Cortizone
Diagnosing

8. • Generally very easy to treat
• Surgery is rarely recommended but is
generally very successful
• Patient’s whose sciatic nerve runs through the
piriformis muscle are more susceptible to
repetitive piriformis syndrome
Prognosis

9. • Non-operative
– Modalities
• Massage, Ultrasound
ice, heat
– Gait training
– Stretching
• Piriformis, external rotators, IT band
– Strengthening
• Gluteals, Adductors, Abductors
– NSAID’s
Treatment

10. • Operative
– Not common
– Surgical release of the piriformis
– Generally a posterior approach
– WBAT post surgery for 2 weeks
Treatment

11. Bibliography
• Kisner, Carolyn. Colby, Lynn Allen. Therapeutic Exercise: Fifth Edition.
Philadelphia: F.A. Davis Company, 2007
• Mid-Tennessee Bone & Joint Clinic P.C. 2006. 22 November 2010
<http://www.mtbj.net/pdf/PiriformisSyndrome.pdf>
• eMedicine: Piriformis Syndrome. 31 March 2010. 22 November 2010
<http://emedicine.medscape.com/article/308798-overview>
• Piriformis Syndrome. 9 November 2010. 19 November 2010
<http://en.wikipedia.org/wiki/Piriformis_syndrome>